The multidisciplinary intervention, which is done as part of a collaborative approach with the young person and their loved ones, has as its primary objective the stabilization of symptoms and the life situation, including the resolution of problems concerning housing, social relationships, income, etc. Then, gradually, the intervention aims to increase the young person's autonomy by reintegrating them into a social role that is meaningful to them. To achieve this, activities integrated into the community and the young person's social environment are prioritized. Support is also offered to young adults to help them return to school or work as quickly as possible. In addition to medication, the individualized treatment plan for each patient and their family combines the following elements:

• One-on-one follow-up with a psychiatrist and a mental health professional;
• Supportive and/or cognitive-behavioural psychotherapy (CBT); and
• Participation in therapeutic groups.

The objectives of the therapeutic groups are to adapt to the psychotic episode by developing social and functional skills, better self-knowledge, achieving life goals and improving personal autonomy. Group approaches are preferred because they offer many benefits through peer support, experience sharing, and breaking isolation.

Counselling and psychological therapy, i.e., having a counsellor to talk to about the situation, is an important part of treatment. The type of discussion and frequency of meetings may vary to best suit the patient and the phase of their illness. For example, a person suffering from acute symptoms may simply want to find someone to reassure them that they are recovering. Subsequently, once the episode of psychosis has resolved, the individual may want to discuss how to manage stress, how to avoid relapses, and recognize early warning signs or how to resume their studies or professional life.

Each patient receives intensive services from a case manager, usually an occupational therapist or social worker, and a psychiatrist for a period of 2 to 5 years. They are then referred to other services according to their needs, such as a general practitioner or adult mental health services. As soon as possible, the young person's life plan is reviewed with them as part of the psychological intervention to help them develop the skills necessary to achieve it or to reassess it if necessary.

At the beginning of treatment at the JAP Clinic, each young patient benefits from one to two (individual) meetings per week. After that, this frequency gradually decreases to about one meeting every two weeks, and rarely less than once a month. They also has access to weekly therapy groups according to their objectives:

Interventions take into account the delicate balance between, on the one hand, the family/community support necessary for the young person's recovery and, on the other hand, the importance of encouraging separation/individuation and the development of the young person's autonomy. The philosophy at the heart of the treatment is to view young adults/adolescents as individuals with life plans and potential who need to adapt to an illness that they must learn to better “manage,” rather than as “vulnerable patients” who must be shielded from life's stresses. This perception allows young people to cultivate hope and reach their full potential while taking their limitations into account.

CBT allows the individual to better understand what is happening to them and to make sense of this event in their life journey. It also aims to identify the reasons why this event occurs at this particular stage of their lives and the strategies to adapt to this phenomenon or to the stress experienced.  It also highlights the individual's strengths and protective factors as well as their vulnerability factors.  It allows the individual to become aware of the link between external events, their emotions and their thoughts and to "rectify" certain ways of thinking that cause distress or difficulties in functioning.

Cognitive behavioural therapy for psychosis has the following three objectives:

• reduce distress and problems with functioning associated with psychotic symptoms,
• reduce anxiety reactions and improve emotional management, and
• Promote the active participation of the individual in the management of their risk of relapse.

Cognitive behavioural therapy is tailored to the needs of each individual and the phase of their illness. The different stages are guided by a formulation of the problems of each individual.   The number of sessions, the duration and the time required for therapy will depend on the complexity and severity of the problems presented as well as the degree of involvement of each individual. Typically, the therapies last 6 months once a week.

COGNITIVE BEHAVIORAL THERAPY FOR DELUSIONS AND HALLUCINATIONS

Cognitive therapy attempts to work specifically on delusions, paranoid interpretations, and beliefs about voices. Depending on each individual's desire to consider alternative explanations for the nature of such experiences, the therapist may attempt to offer more scientific explanations or work with each individual's beliefs. It can also be useful to rename the experiences and de-dramatize the situation, which is often related to very intense emotions for the patient.

WORK ON COGNITIVE ISSUES ABOUT SELF AND OTHERS

Cognitive therapy for psychosis aims to address problems with thinking about oneself and others. The types of cognition that are typically addressed are those that imply that the patient has no value, is bad or dangerous, or that others are essentially untrustworthy or likely to harm them.

All components of the group program are seen as a continuum in the recovery and resumption of a social role. Groups are offered from the beginning of acute phase treatment (whether inpatient or outpatient). Different skills are thus solicited and worked on:

• Punctuality,
• Attendance,
• Tolerance to effort,
• The development of social skills related to the resumption of a social role (e.g., work, studies, friendships, etc.),
• The acquisition of a lifestyle routine, and
• Scheduling management.

GROUP INTERVENTION

The choice of groups is made according to the needs of the young people and their development. Typically, young people will benefit from group interventions during the first few weeks of their treatment, and then the program allows for the temporary resumption of groups, if there is a relapse of symptoms or a decrease in social or vocational functioning. The groups also aim to improve self-criticism in relation to one's mental health, the demands/skills of returning to activities of daily living and returning to work or school. The groups use the strength of peers to stimulate motivation, hope, sharing and the development of self-criticism.

GENERAL OBJECTIVES OF THE JAP GROUPS

• Meet other young people and promote communication,
• Resuming a routine and maintaining regular engagement by participating in structured activities,
• Improve punctuality and attendance; To meet their commitments by attending scheduled group sessions.
• Promote tolerance in group situations: feel more comfortable while interacting with people.
• Promoting frustration tolerance: improving how you react or think when faced with difficult situations (in relation to your peers, therapists, or when carrying out an activity), and
• Improve your social skills: initiate contact, exchange, express your opinion or experience, listen to others when they speak, etc.

GROUP INTERVENTION IN TELECONSULTATION

The JAP Clinic now offers group interventions by teleconsultation. If you have been invited to participate in a virtual group, please review the following guides available for download (PDF):

• Virtual Zoom Groups - JAP CHUM Clinic - Participant's Guide (Abbreviated)
• Virtual Groups on Zoom - JAP CHUM Clinic - Participant's Guide

A Facilitator's Guide for Virtual Groups on Zoom is also available for download by clicking here.

Some groups are offered on an ongoing basis and can be integrated at any time during the evolution as needed.

When you want to return to work, as part of the job search process or when you start working, many unforeseen difficulties can arise.

The objectives of this group are:

• Help you develop skills to understand and better manage these challenges, with the goal of having a positive work experience,
• Discover new tools and strengthen personal skills to better cope with stressful situations or psychotic symptoms.

Individual sessions or a group program can be offered to help these young people find strategies adapted to their needs.

The objective: to provide an extraordinary experience in a natural therapeutic environment through an outdoor activity taking place off the island of Montreal in a nature park.

• Have a positive and rewarding experience,
• Promote investment in a project and bring it to completion,
• Promote adherence to the treatment offered at the JAP Clinic,
• Have better self-esteem and develop a sense of accomplishment,
• Develop their problem-solving skills, and
• Improve their social and relational skills in a group.

The activity includes excursion planning and exchange groups as well as outdoor sports activity groups.

Click here for all the details or talk to your counsellor.

The philosophy behind the treatment is to view young adults and adolescents as individuals with life plans and potential who need to adapt to an illness they must learn to “manage,” rather than as “vulnerable patients” who must be shielded from life's stresses because of their chronic disability. This perception allows young people to cultivate hope and reach their full potential while taking their limitations into account.

Examples of strategies used to facilitate rapid but gradual reintegration into employment include:

1. Temporary change in the type of task and/or part-time work,
2. Job less demanding than usual/previous job,
3. Vocational training (initially short-term),
4. Return to school on a part-time basis first (depending on the youth's profile), and
5. Reorientation as needed (if the old field causes too much stress).

Despite the myths on this subject, it is not desirable, at the beginning of an illness, to "declare" a young person unfit for work for a long period of time without having attempted, at the appropriate time, a gradual reintegration into a socio-professional or academic project adapted to the young person's abilities and limitations. In doing so, we avoid undermining the hope and motivation to realize the potential of each individual.

Starting a new job can be stressful and too much stress is a risk factor for psychotic relapse. That's why it's important to keep in mind some tips and advice to keep your balance.

Nearly half of young people who have a first episode of psychosis manage to return to work or school after three months. Even if it may take time, it is realistic to think about eventually resuming the same or a similar life plan and continuing a rewarding and independent life, despite the psychosis.

In order to facilitate the return to work and/or school, efforts are made to provide a lot of flexibility and ongoing support, including:

• Job search support (resume assistance, search strategies, coaching, interview practices, etc.),
• Meetings outside of regular working hours,
• Adjustment of the frequency of appointments to take into account the youth job and development, e.g., more frequent in times of crisis and decrease thereafter to avoid scheduling conflicts,
• Telephone follow-up either by appointment or according to the needs of the young person,
• Partnership with Stevedoring, a job placement and support organization,
• Partnership with integration resources or the employer if the young person wishes,
• Discussions with the navigator and the employer,
• Adaptation of tasks or pace to facilitate integration, if necessary, and
• Better matching between employer/integration program and employee.